BACKGROUND & AIMS: The impact of childhood Crohn's disease (CD) on volumetric bone mineral density (vBMD), bone structure, and muscle mass have not been established. The objective of this longitudinal study was to assess musculoskeletal outcomes in an incident cohort of children with CD using peripheral quantitative computed tomography (pQCT). METHODS: Tibia pQCT was performed in 78 CD subjects (ages, 5-18 years) at diagnosis and in 67 over the subsequent year. pQCT outcomes were converted to sex- and race-specific z scores based on reference data in over 650 controls. Multivariable linear regression models identified factors associated with changes in bone outcomes. RESULTS: At diagnosis, CD subjects had significant deficits in trabecular vBMD (z score, -1.32+/-1.32; P< .001), cortical section modulus (a measure of bone geometry and strength) (z score, -0.44+/-1.11; P< .01), and muscle (z score, -0.96+/-1.02; P< .001) compared with controls. Over the first 6 months, trabecular vBMD and muscle z scores improved significantly (both, P< .001); however, section modulus worsened (P= .0001), and all 3 parameters remained low after 1 year. Increases in muscle z scores were associated with less severe declines in cortical section modulus z scores. Improvements in trabecular vBMD z scores were greater in prepubertal subjects. Glucocorticoids were associated with increases in cortical vBMD. CONCLUSIONS: Substantial deficits in trabecular vBMD, cortical bone geometry, and muscle were observed at CD diagnosis. Trabecular vBMD improved incompletely; however, cortical deficits progressed despite improvements in muscle. Glucocorticoids were not associated with bone loss. Therapies to improve bone accrual in childhood CD are needed.
BACKGROUND & AIMS: The impact of childhood Crohn's disease (CD) on volumetric bone mineral density (vBMD), bone structure, and muscle mass have not been established. The objective of this longitudinal study was to assess musculoskeletal outcomes in an incident cohort of children with CD using peripheral quantitative computed tomography (pQCT). METHODS: Tibia pQCT was performed in 78 CD subjects (ages, 5-18 years) at diagnosis and in 67 over the subsequent year. pQCT outcomes were converted to sex- and race-specific z scores based on reference data in over 650 controls. Multivariable linear regression models identified factors associated with changes in bone outcomes. RESULTS: At diagnosis, CD subjects had significant deficits in trabecular vBMD (z score, -1.32+/-1.32; P< .001), cortical section modulus (a measure of bone geometry and strength) (z score, -0.44+/-1.11; P< .01), and muscle (z score, -0.96+/-1.02; P< .001) compared with controls. Over the first 6 months, trabecular vBMD and muscle z scores improved significantly (both, P< .001); however, section modulus worsened (P= .0001), and all 3 parameters remained low after 1 year. Increases in muscle z scores were associated with less severe declines in cortical section modulus z scores. Improvements in trabecular vBMD z scores were greater in prepubertal subjects. Glucocorticoids were associated with increases in cortical vBMD. CONCLUSIONS: Substantial deficits in trabecular vBMD, cortical bone geometry, and muscle were observed at CD diagnosis. Trabecular vBMD improved incompletely; however, cortical deficits progressed despite improvements in muscle. Glucocorticoids were not associated with bone loss. Therapies to improve bone accrual in childhood CD are needed.
Authors: Cynthia L Ogden; Robert J Kuczmarski; Katherine M Flegal; Zuguo Mei; Shumei Guo; Rong Wei; Laurence M Grummer-Strawn; Lester R Curtin; Alex F Roche; Clifford L Johnson Journal: Pediatrics Date: 2002-01 Impact factor: 7.124
Authors: Helen M Pappa; Tracee M Saslowsky; Rajna Filip-Dhima; Diane DiFabio; Hajar Hassani Lahsinoui; Apurva Akkad; Richard J Grand; Catherine M Gordon Journal: Am J Gastroenterol Date: 2011-04-26 Impact factor: 10.864
Authors: Anniek M Terpstra; Heidi J Kalkwarf; Justine Shults; Babette S Zemel; Rachel J Wetzsteon; Bethany J Foster; C Frederic Strife; Debbie L Foerster; Mary B Leonard Journal: J Am Soc Nephrol Date: 2012-01-26 Impact factor: 10.121
Authors: J Feber; I Gaboury; A Ni; N Alos; S Arora; L Bell; T Blydt-Hansen; C Clarson; G Filler; J Hay; D Hebert; B Lentle; M Matzinger; J Midgley; D Moher; M Pinsk; F Rauch; C Rodd; N Shenouda; K Siminoski; L M Ward Journal: Osteoporos Int Date: 2011-04-15 Impact factor: 4.507
Authors: Lindsay M Griffin; Meena Thayu; Robert N Baldassano; Mark D DeBoer; Babette S Zemel; Michelle R Denburg; Lee A Denson; Justine Shults; Rita Herskovitz; Jin Long; Mary B Leonard Journal: J Clin Endocrinol Metab Date: 2015-04-28 Impact factor: 5.958